Seasonal clustering of sarcoidosis presenting with erythema nodosum

Wilsher, M. L.

doi:10.1183/09031936.98.12051197

Cited by 62 publications

(32 citation statements)

References 11 publications

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“…Cutaneous lesions are present in ~25% of sarcoidosis patients [13]. The skin lesions could have specific aspects (papules, plaques, nodules, alopecia or purple scars) or can be more or less nonspecific (erythema nodosum) [14]. In the Netherlands epidemiological study sarcoidosis was mostly associated with rheumatoid arthritis [15].…”

Section: Discussionmentioning

confidence: 99%

A rare case of pulmonary tuberculosis with simultaneous pulmonary and skin sarcoidosis: a case report

et al. 2010

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BackgroundTuberculosis and sarcoidosis are chronic diseases that rarely occur concomitantly. Sarcoidosis is a multisystem granulomatous disorder characterized pathologically by the presence of non-caseating granulomas in involved tissues. Tuberculosis is infectious disease caused by Mycobacterium tuberculosis characterized by granulomas with caseous necrosis.Case presentationWe present a case of 43-year-old female refugee from Kosovo with microbiological confirmation of pulmonary tuberculosis and pulmonary and skin sarcoidosis at the same time. Three weeks after corticosteroid therapy for pulmonary sarcoidosis was introduced, positive finding of mycobacterium culture of bronchial aspirate was observed. Based on these results, corticosteroid therapy was excluded and antituberculous therapy was introduced for six months. In the meantime, new nodes on face and nose appeared and skin sarcoidosis was diagnosed. The patient was given corticosteroids and colchicine according to the skin and pulmonary sarcoidosis therapy recommendation.ConclusionThe authors of this study suggest that in cases when there is a dilemma in diagnosis between tuberculosis and sarcoidosis we should advance with corticosteroid therapy until we have microbiological confirmation of mycobacterium culture. This case is remarkable because this is a third described case of sarcoidosis and tuberculosis together (the first reported in Asia, the second in South Africa), and to authors knowledge, this is a first case report in Europe.

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Section: Discussionmentioning

confidence: 99%

A rare case of pulmonary tuberculosis with simultaneous pulmonary and skin sarcoidosis: a case report

et al. 2010

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“…Seasonal clustering of sarcoidosis cases to the late winter or early spring months (relative to the respective northern or southern hemispheres) supports an environmental cause that triggers sarcoidosis [56]. Associations of sarcoidosis with specific occupations such as healthcare professionals, military personnel, agricultural workers, and fire/rescue workers also support a potential link between the local environments and risk for developing sarcoidosis.…”

Section: Environmental Studies Of Sarcoidosis Etiologymentioning

confidence: 94%

Etiologies of Sarcoidosis

Chen

Möller

2015

Clinic Rev Allerg Immunol

125

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Since sarcoidosis was first described more than a century ago, the etiologic determinants causing this disease remain uncertain. Studies suggest that genetic, host immunologic, and environmental factors interact together to cause sarcoidosis. Immunologic characteristics of sarcoidosis include non-caseating granulomas, enhanced local expression of T helper-1 (and often Th17) cytokines and chemokines, dysfunctional regulatory T-cell responses, dysregulated Toll-like receptor signaling, and oligoclonal expansion of CD4+ T cells consistent with chronic antigenic stimulation. Multiple environmental agents have been suggested to cause sarcoidosis. Studies from several groups implicate mycobacterial or propionibacterial organisms in the etiology of sarcoidosis based on tissue analyses and immunologic responses in sarcoidosis patients. Despite these studies, there is no consensus on the nature of a microbial pathogenesis of sarcoidosis. Some groups postulate sarcoidosis is caused by an active viable replicating infection while other groups contend there is no clinical, pathologic, or microbiologic evidence for such a pathogenic mechanism. The authors posit a novel hypothesis that proposes that sarcoidosis is triggered by a hyperimmune Th1 response to pathogenic microbial and tissue antigens associated with the aberrant aggregation of serum amyloid A within granulomas, which promotes progressive chronic granulomatous inflammation in the absence of ongoing infection.

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“…Southern hemisphere countries show a clustering towards the spring months (August–October) 68. Any relationship of this seasonal clustering to specific antigen sources, including confinement in buildings and homes in winter months, agriculture, forestry, insecticides, bio-aerosols and activity in the construction industry, is unclear.…”

Section: Environmental Factorsmentioning

confidence: 99%

Sarcoidosis: the links between epidemiology and aetiology

Dubrey

Shah

Hardman³

et al. 2014

Postgraduate Medical Journal

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Sarcoidosis is a multisystem inflammatory disease, the aetiology of which has still to be resolved. The proposed mechanism is that a susceptible genotype is exposed to one or more potential antigens. A sustained inflammatory response follows, which ultimately results in pathognomonic granuloma formation. Various clinical phenotypes exist with specific genetic associations influencing disease susceptibility, protection, and clinical progression. Occupational and environmental factors, including microbial elements, may then effect the development of this disease. Sarcoidosis is a heterogeneous disease, showing geographic and racial variation in clinical presentation. It demonstrates a familial tendency and clear genotype associations. Additionally, it appears to cluster within closely associated populations (eg, work colleagues) and appears to be related to selected occupations and environmental exposures. Frequently occult, but occasionally fatal, this disease has a very variable prognosis. It is also unusual in having no specific biomarker. The epidemiology and multiple factors that appear to influence the aetiology of sarcoidosis illustrate why this disease state is frequently described as a clinical enigma.

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Seasonal clustering of sarcoidosis presenting with erythema nodosum

Cited by 62 publications

References 11 publications

A rare case of pulmonary tuberculosis with simultaneous pulmonary and skin sarcoidosis: a case report

A rare case of pulmonary tuberculosis with simultaneous pulmonary and skin sarcoidosis: a case report

Etiologies of Sarcoidosis

Sarcoidosis: the links between epidemiology and aetiology

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